Sex- and Gender-Based Analysis (SGBA): Importance in Health Research

By Gwenyth Brockman

In keeping with SGBA awareness week, we thought we would take the opportunity to look at the role of sex and gender in health and the importance of SGBA in patient and public engagement in health research.

The Difference Between Sex & Gender

Sex and gender are distinct concepts that are sometimes confused and conflated. However, they are different and it’s important to distinguish between the two. Typically, we think of sex as being biological - a multidimensional construct that includes physical features, anatomy, physiology, gene expression, and hormone levels. Gender, on the other hand, is a social construct based on the norms and expectations regarding a person’s behaviour and their role in society, based on their sex. Gender is culturally and historically specific, and is intricately linked to social and economic status [1].

Historically, sex was divided into males and females depending on whether an individual has two X chromosomes (XX; female) or one X, one Y (XY; male). It’s now understood as a less rigid feature, where some individuals may be intersex, with a mix of characteristics that may be male or female. Similarly, gender is no longer solely represented by binary categories of man/woman or girl/boy. Rather, gender is a spectrum and individuals may identify as fully male, fully female, somewhere in between, neither, or by another gender identity. For a good resource on sex/gender and other definitions check out this site.

The notion of gender and sex being distinct is still fairly new, but it is now understood that each can influence health in different ways. There are discrete sex differences in the physiology and hormonal profiles of the body that influence risk factors, progression/signs of disease, and effectiveness of treatments. Gender can also affect health in numerous ways including exposure to risk factors or vulnerability, access to and experiences in health care settings, and social impacts of health.

Sex & Gender in Research

As researchers, we should include an analysis on sex and gender in our own research, when appropriate, to identify where there are differences and similarities. Including a sex- and gender-based analysis (SGBA) typically makes research more equitable, valid, and generalizable. Due to its recognized importance, SGBA is now required by certain funding bodies, including CIHR, WHO, UN and PAHO. If you want to learn more, there are many resources that can help you incorporate SGBA in your own research (Rising to the Challenge, CIHR, Cochrane Collaboration, CWHN).

For example, when designing a questionnaire for research participants, you may want to consider the importance of sex and gender differences, and ensure you are providing more than the binary man/woman option if you are asking a person about their gender identity.

Sex & Gender in Patient and Public Engagement

Considerations of sex and gender identity are also crucial when it comes to patient and public engagement in health research. Different challenges and barriers come with engaging with men, women, and people who are gender diverse or gender fluid. And once involved in research, there may also be differences in the ways they will require support to continue to be engaged in a meaningful way. Most importantly though, are the benefits that come from engaging a diverse group as they will be able to share different experiences based on their sex and gender, adding value and meaning to your research. The Awesome Model incorporates a “gender lens” which encourages researchers to be gender sensitive in their planning; reflecting on gender differences and how they will affect patient engagement in research. Ensuring engagement is informed by SGBA is critical to creating health care solutions that are inclusive and responsive to various social determinants of health, many of which are gender-specific.

References

1. Johnson JL, Greaves L & Repta R. Better Science with Sex and Gender: A Primer for Health Research. Vancouver, 2007: Women’s Health Research Network.

About the Author

Gwenyth Brockman is a former Research Assistant with the George and Fay Yee Centre for Healthcare Innovation in the Knowledge Translation Platform.